Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Tarsal tunnel syndrome is compression of the posterior tibial nerve as it passes through the tarsal tunnel — a narrow space behind the medial (inner) ankle. It is the foot and ankle equivalent of carpal tunnel syndrome in the wrist, causing burning, tingling, electric shock, or numbness radiating from the inner ankle into the sole and toes. It is one of the most commonly misdiagnosed causes of chronic foot and ankle pain. At Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan, Dr. Tom Biernacki, DPM diagnoses tarsal tunnel syndrome accurately and manages it without unnecessary surgery in most cases.

Quick Answer: Tarsal Tunnel Syndrome

Tarsal tunnel syndrome causes burning, tingling, shooting pain, or numbness on the bottom of the foot and inner ankle — typically worsening with prolonged standing, walking, or at night. Tinel’s sign (tapping the medial ankle reproduces the tingling) is the key physical examination finding. EMG/nerve conduction studies confirm the diagnosis and grade severity. Most cases respond to orthotics (to reduce nerve traction from flat feet), anti-inflammatory treatment, and corticosteroid injection. Surgery (tarsal tunnel release) is effective for confirmed cases that fail conservative care, with success rates of 70–90%. See a podiatrist before extensive neurological workup — peripheral causes of foot burning are frequently overlooked by non-podiatry specialists.

Anatomy of the Tarsal Tunnel

The tarsal tunnel is a fibro-osseous canal on the medial side of the ankle, bounded by the medial malleolus anteriorly and the flexor retinaculum (the roof of the tunnel) posteriorly. The posterior tibial nerve, tibial artery, and three flexor tendons all pass through this tight space. The posterior tibial nerve divides inside or just distal to the tunnel into three branches: the medial plantar nerve (big toe side of the foot), the lateral plantar nerve (little toe side), and the medial calcaneal nerve (heel). Depending on which branch is compressed, symptoms may be localized to specific zones of the foot.

Symptoms of Tarsal Tunnel Syndrome

• Burning, tingling, or electric shock sensation along the medial ankle, heel, and sole
• Numbness in the bottom of the foot and toes (may spare the heel if medial calcaneal nerve is not involved)
• Pain that worsens with prolonged standing or walking and improves with rest
• Symptoms often worse at night — “restless foot”
• Pain radiating into the calf (retrograde spread along tibial nerve)
• Positive Tinel’s sign: tapping the posterior tibial nerve behind the medial malleolus reproduces tingling in the foot
• Weakened toe flexion in advanced cases (intrinsic muscle involvement)

Causes of Tarsal Tunnel Syndrome

Tarsal tunnel syndrome has multiple potential causes, all of which increase pressure within the tunnel. Identifying the specific cause guides treatment:

• Flat feet / overpronation — Excessive pronation pulls the posterior tibial nerve taut around the medial malleolus; the most common biomechanical cause
• Posterior tibial tendon dysfunction (PTTD) — Progressive flat foot deformity increases tarsal tunnel tension
• Ganglion cyst or lipoma in the tunnel — Space-occupying lesion compresses the nerve
• Ankle fracture or trauma — Post-traumatic scarring, bone fragment, or ligament hypertrophy
• Heel valgus — Any condition causing the heel to tilt inward increases nerve traction
• Systemic inflammation — Rheumatoid arthritis, hypothyroidism (soft tissue swelling), and diabetes (nerve susceptibility)
• Varicosities — Dilated veins within the tarsal tunnel compress the nerve

Diagnosis: EMG Is Required for Surgical Planning

Clinical diagnosis relies on Tinel’s sign, symptom distribution mapping, and biomechanical assessment. However, EMG and nerve conduction velocity (NCV) studies are required to confirm the diagnosis objectively, differentiate from lumbar radiculopathy (L4/L5/S1), diabetic peripheral neuropathy, and other conditions, and assess severity before surgical planning. MRI or ultrasound is used to identify space-occupying lesions (ganglion, lipoma, varicosity) within the tunnel when clinical examination or conservative treatment response suggests a structural cause.

Differential Diagnosis: Other Causes of Foot Burning & Numbness

• Peripheral diabetic neuropathy — Bilateral, “stocking” distribution; no Tinel’s; begins at toes and spreads proximally
• Lumbar radiculopathy (L4/L5/S1) — Back and leg symptoms; positive straight leg raise; MRI lumbar spine
• Baxter’s neuropathy — Compression of the inferior calcaneal (Baxter’s) nerve; lateral heel numbness; no medial ankle Tinel’s
• Morton’s neuroma — 3rd–4th webspace burning; no medial ankle Tinel’s; Mulder’s click positive
• Plantar fasciitis — Heel pain with first steps; no tingling or numbness; no Tinel’s
• Complex regional pain syndrome (CRPS) — Burning with allodynia, skin changes, autonomic dysfunction; often post-traumatic

Conservative Treatment

Conservative treatment is appropriate for all patients with tarsal tunnel syndrome as first-line management, particularly when there is no space-occupying lesion on imaging.

• Custom orthotics — Medial arch support reduces pronation and decreases traction on the posterior tibial nerve; the single most effective conservative intervention for flat foot-related tarsal tunnel
• NSAIDs — Reduce perineural inflammation; useful for short-term management
• Corticosteroid injection — Ultrasound-guided injection around the nerve reduces swelling and inflammation; provides significant relief in 50–70% of patients for 3–6 months
• Night splinting — Prevents overnight plantar flexion that maintains nerve tension; can reduce nocturnal burning
• Activity modification — Reducing prolonged standing or walking during active flares
• Neuropathic pain medication — Gabapentin or duloxetine for symptom management while structural treatment is optimized (prescribed in coordination with primary care)

Surgical Treatment: Tarsal Tunnel Release

Tarsal tunnel release (surgical decompression) involves cutting the flexor retinaculum to relieve pressure on the nerve and exploring the tunnel for space-occupying lesions. Success rates are 70–90% for properly selected patients — those with confirmed EMG findings, identifiable structural cause, and failed conservative treatment of at least 4–6 months. Success rates are lower in patients with systemic diabetes, bilateral symptoms, or no identifiable structural cause. Post-surgical recovery involves 4–6 weeks non-weight-bearing or partial weight-bearing, with symptom improvement continuing for 6–12 months as the nerve heals.

Most Common Mistake

The most common mistake: treating all foot burning and tingling as peripheral neuropathy (especially in diabetic patients) without examining for tarsal tunnel syndrome. Tarsal tunnel syndrome coexists with diabetic neuropathy and is a separate, treatable component. Patients who have “neuropathy” that is predominantly on the bottom of one foot, with a positive Tinel’s at the medial ankle, have tarsal tunnel syndrome until proven otherwise — and may achieve significant additional relief from decompression or orthotic correction even in the setting of systemic neuropathy.

Tarsal Tunnel Treatment in Michigan

Dr. Tom Biernacki, DPM at Balance Foot & Ankle evaluates tarsal tunnel syndrome with clinical nerve examination, orthotic management, ultrasound-guided injections, and surgical consultation at both our Howell and Bloomfield Hills locations. Call (810) 206-1402 or book online.

Related Guides

• Baxter’s Neuropathy — Calcaneal Nerve Entrapment
• Morton’s Neuroma Guide
• Posterior Tibial Tendon Dysfunction (PTTD)
• Custom Orthotics in Michigan
• Diabetes & Foot Complications Guide

Expert Nerve Treatment in Michigan

Tarsal tunnel syndrome causes numbness, tingling, and burning in the foot. Our podiatrists use nerve conduction studies and advanced imaging to diagnose and treat this compression neuropathy effectively.

See Our Nerve Treatment Services → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Ahmad M, Tsang K, Mackenney PJ, Adedapo AO. “Tarsal tunnel syndrome: a literature review.” Foot and Ankle Surgery. 2012;18(3):149-152.
2. Lau JT, Daniels TR. “Tarsal tunnel syndrome: a review of the literature.” Foot & Ankle International. 1999;20(3):201-209.
3. Franson J, Baravarian B. “Tarsal tunnel syndrome: a compression neuropathy involving four distinct tunnels.” Clinics in Podiatric Medicine and Surgery. 2006;23(3):593-609.